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    The Organ Waiting List System Could Be Made More Fair


    Under the regulation in question, proposed by the HHS in April 1998, the current system of regional organ distribution would be revised, as the regulation states, to "assure that allocation of organs will be based on common medical criteria, not accidents of geography." The "Organ Procurement and Transplantation Network: Final Rule," or "Final Rule" for short, calls for enhanced federal oversight of organ procurement, increased public access to important information, and shifting of emphasis away from geographical considerations to medical needs.

    But implementation of the Final Rule has been held up by political wrangling. In October 1998, Congress suspended the regulation for one year and asked the IOM specifically to study the issue and come up with recommendations. Then on Dec. 17, 1999, President Clinton signed into law the "Ticket-to-Work and Work Incentives Improvement Act of 1999," which, against his administration's wishes, included a 90-day moratorium on implementation of the Final Rule that had been slipped into the legislation by Senate Majority Leader Trent Lott, R-Miss.

    The earliest the new regulations could go into effect would be mid-March 2000, but further delay is likely as Congress plans to reconsider the issue as part of a bill to reauthorize the National Organ Transplant Act.

    Congress, with the support of many of the nation's transplant surgeons and centers, may consider legislation that would strip the government of much of its current authority over organ procurement. Such legislation would fly directly in the face of the IOM recommendations to Congress.

    Politics in Washington and in the field of transplant medicine are fueling debate over the proposed changes. "The issue regionally is competing OPOs," says Frederick Gordon, MD, director of hepatology and medical director of the liver transplant program at the Lahey Clinic in Burlington, Mass.

    In an interview with WebMD, Gordon says that he generally supports the Final Rule, but understands why some OPOs are nervous about the prospect of change: "I think there's some potential for improvement in areas where there are OPOs that are geographically close and are competing for the patients in the same distribution region. If there are some changes, however, there is a risk that if you're going to abolish competition among OPOs and there's a massive program in the same city with a tiny OPO, that little program is going to go out of business."

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